Provider Demographics
NPI:1730834219
Name:AMADA FAMILY THERAPY LLC
Entity type:Organization
Organization Name:AMADA FAMILY THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLIBA
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:714-883-8245
Mailing Address - Street 1:18627 BROOKHURST ST # 233
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-6748
Mailing Address - Country:US
Mailing Address - Phone:714-883-8245
Mailing Address - Fax:
Practice Address - Street 1:16755 VON KARMAN AVE STE 200
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-4963
Practice Address - Country:US
Practice Address - Phone:714-756-0826
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty